Gastrointestinal Biopsy May Determine Risk of Neurodegenerative Disease

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People who had a gastrointestinal biopsy of normal mucosa or nonspecific inflammation were shown to be at increased risk of Alzheimer’s and Parkinson’s disease.

Gastrointestinal (GI) biopsy of normal mucosa or nonspecific inflammation increases the risk of Alzheimer’s disease (AD), Parkinson’s disease (PD), according to research results published in European Journal of Neurology.

AD and PD are neurodegenerative diseases characterized by progressive and selective loss of neurons in the central nervous system. Evidence to date suggests that gastrointestinal symptoms may function as prodromal non-motor symptoms of neurodegenerative disease, and gastrointestinal symptoms and conditions (e.g., inflammatory bowel disease, irritable bowel syndrome) may subsequently associated with risk of AD and PD in

“However, in clinical practice, the most frequent histologic findings on gastrointestinal endoscopy are normal histologic features, namely normal mucosa (usually untreated) and inflammation not classified as an inflammatory disease. It’s a histological change, or non-specific inflammation,” the researchers explained. “Therefore, to investigate the subsequent risk of neurodegenerative disease among individuals with gastrointestinal symptoms who require gastrointestinal endoscopy but who have histologically normal mucosa or evidence of non-specific inflammation. It’s interesting and relevant.”

They used information on individuals with gastrointestinal histopathological records available from 28 Swedish pathology departments between 1965 and 2016 and up to five individuals per randomly selected index person. We performed a registry-based cohort analysis of the nationally matched ESPRESSO study, including information on: From the Swedish General Population Register.

Eligible participants had normal mucosa (n = 480,346; mean age 44 years; 62% female patients) or non-specific inflammation (n = 655,937; mean age 52 years; 51% female patients) since 1965. ) were included in Swedish individuals who underwent a gastrointestinal biopsy. to 2016 (exposed group), and their individually matched population references and unexposed full siblings.

Among study cohorts, individuals with normal mucosa tended to have more health care visits, a higher Charlson comorbidity index, and a higher prevalence of previous gastrointestinal disease.

During a mean 12-year follow-up period, the incidence of AD was 84.10 per 100,000 person-years in individuals with normal mucosa and 78.81 per 100,000 person-years in matched references. The corresponding figures were 40.66 vs 36.20 per 100,000 person-years of PD. For individuals with nonspecific inflammation and their matched references, the incidence was 129.26 vs 129.76 per 100,000 person-years for AD and 63.64 vs 60.22 per 100,000 person-years for PD.

Findings showed that patients with intact mucosa or nonspecific inflammation were at increased risk of AD and PD 20 years after biopsy.

  • People with normal mucosa were at increased risk of AD compared with the population reference (incidence [IR] Difference: 13.53 per 100,000 person-years. HR, 1.15; 95% CI, 1.11-1.20) and PD (IR difference: 6.72; HR, 1.16; 95% CI, 1.10-1.23)
  • Compared with the population reference, individuals with nonspecific inflammation had AD (IR difference: 13.28; HR, 1.11; 95% CI, 1.08-1.14) and PD (IR difference: 6.83; HR, 1.10; 95 % CI, 1.06–1.14)

Similar results were observed in subgroup and sensitivity analyses, and when compared with unexposed siblings. A lack of information regarding indications for gastrointestinal biopsy was cited as a potential limitation of the study results. In addition, caution should be exercised in generalizing findings to other areas, as the incidence and prevalence of AD and PD varies by country, researchers said.

They concluded that the findings add new evidence to the early involvement of gastrointestinal dysfunction in neurodegenerative diseases.


Sun J, Ludvigsson JF, Roelstraete B, et al. Gastrointestinal biopsy of normal mucosa or nonspecific inflammation and risk of neurodegenerative disease: a nationally matched cohort study. Eur J NeurolPublished online November 29, 2022. doi:10.1111/ene.15654

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